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Pre-eclampsia before 20-week gestation: diagnosis, investigation and management.

Schena FP, Thomas W, Griffiths M, Nelson-Piercy C, Sinnamon K - Clin Kidney J (2012)

View Article: PubMed Central - PubMed

Affiliation: Department of Renal Medicine , Colchester Hospital , Colchester , UK.

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Pre-eclampsia (PET) is a hypertensive disorder of pregnancy predominantly occurring after 20-week gestation... She then had a normal vaginal delivery, with a resulting stillborn foetus, complicated by the need for evacuation of retained placental products... BP, renal and liver function improved... As PET and some glomerulopathies may have similar clinical and laboratory findings, and given that the patient was only 16 weeks pregnant and fell out of the conventional time frame for PET, a kidney biopsy was important to clearly identify the diagnosis and to direct management... In later stages of pregnancy, there is more certainty that new-onset hypertension and proteinuria, possibly with other supportive clinical features, is likely to represent PET and therefore kidney biopsy could potentially be delayed until after delivery... Prior to 34-week gestation, steroids can be considered to aid foetal lung maturity, but the overall strategy is to delay the need for delivery as long as it is safe... After 34 weeks, delivery is generally safer for the foetus... Our patient required multiple oral anti-hypertensives to control her hypertension and was prescribed low-dose molecular-weight heparin given her risk factors for venous thromboembolism along with low-dose aspirin... The usage of low-dose aspirin is recommended by the National Institute of Clinical Excellence and a recent meta-analysis has indicated benefit in preventing PET in high-risk women... In spite of these medical interventions, our patient developed a worsening clinical picture with deteriorating renal and liver function tests which, along with severe foetal IUGR, resulting in the decision to terminate the pregnancy... As PET has been identified as a risk factor for future cardiovascular events, long-term follow-up to modify BP and cholesterol is advisable... In conclusion, this report adds further to the medical knowledge of very early PET... PET can occur before 20-week gestation and should be considered in the differential diagnosis of any pregnant woman with new-onset hypertension and proteinuria, irrespective of gestation... Kidney biopsy is safe in pregnancy and may be crucial in distinguishing PET from other glomerulopathies.

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Light microscopy of the renal biopsy at ×400 magnification using a silver stain. The glomerulus is bloodless. The capillary lumina is obliterated by the endothelial cell swelling with foci of reduplication of the capillary walls (at 9 O'clock) with mesangial interposition. This is consistent with pre-eclamptic nephropathy.
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SFS101F1: Light microscopy of the renal biopsy at ×400 magnification using a silver stain. The glomerulus is bloodless. The capillary lumina is obliterated by the endothelial cell swelling with foci of reduplication of the capillary walls (at 9 O'clock) with mesangial interposition. This is consistent with pre-eclamptic nephropathy.

Mentions: By 20-week gestation, she developed uncontrolled hypertension. Creatinine increased to 101 μmol/L with a urinary protein/creatinine ratio (PCR) of 482 mg/mmol. ALT increased to 114 (0–34 IU/L). The peak PCR was 962 mg/mmol. Blood film showed fragmented red cells. She remained asymptomatic apart from increasing oedema of the legs, hands and face. As the aetiology of her renal diagnosis was unclear, we proceeded to a kidney biopsy, which confirmed the diagnosis of PET (Figures 1 and 2).Fig. 1.


Pre-eclampsia before 20-week gestation: diagnosis, investigation and management.

Schena FP, Thomas W, Griffiths M, Nelson-Piercy C, Sinnamon K - Clin Kidney J (2012)

Light microscopy of the renal biopsy at ×400 magnification using a silver stain. The glomerulus is bloodless. The capillary lumina is obliterated by the endothelial cell swelling with foci of reduplication of the capillary walls (at 9 O'clock) with mesangial interposition. This is consistent with pre-eclamptic nephropathy.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400545&req=5

SFS101F1: Light microscopy of the renal biopsy at ×400 magnification using a silver stain. The glomerulus is bloodless. The capillary lumina is obliterated by the endothelial cell swelling with foci of reduplication of the capillary walls (at 9 O'clock) with mesangial interposition. This is consistent with pre-eclamptic nephropathy.
Mentions: By 20-week gestation, she developed uncontrolled hypertension. Creatinine increased to 101 μmol/L with a urinary protein/creatinine ratio (PCR) of 482 mg/mmol. ALT increased to 114 (0–34 IU/L). The peak PCR was 962 mg/mmol. Blood film showed fragmented red cells. She remained asymptomatic apart from increasing oedema of the legs, hands and face. As the aetiology of her renal diagnosis was unclear, we proceeded to a kidney biopsy, which confirmed the diagnosis of PET (Figures 1 and 2).Fig. 1.

View Article: PubMed Central - PubMed

Affiliation: Department of Renal Medicine , Colchester Hospital , Colchester , UK.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Pre-eclampsia (PET) is a hypertensive disorder of pregnancy predominantly occurring after 20-week gestation... She then had a normal vaginal delivery, with a resulting stillborn foetus, complicated by the need for evacuation of retained placental products... BP, renal and liver function improved... As PET and some glomerulopathies may have similar clinical and laboratory findings, and given that the patient was only 16 weeks pregnant and fell out of the conventional time frame for PET, a kidney biopsy was important to clearly identify the diagnosis and to direct management... In later stages of pregnancy, there is more certainty that new-onset hypertension and proteinuria, possibly with other supportive clinical features, is likely to represent PET and therefore kidney biopsy could potentially be delayed until after delivery... Prior to 34-week gestation, steroids can be considered to aid foetal lung maturity, but the overall strategy is to delay the need for delivery as long as it is safe... After 34 weeks, delivery is generally safer for the foetus... Our patient required multiple oral anti-hypertensives to control her hypertension and was prescribed low-dose molecular-weight heparin given her risk factors for venous thromboembolism along with low-dose aspirin... The usage of low-dose aspirin is recommended by the National Institute of Clinical Excellence and a recent meta-analysis has indicated benefit in preventing PET in high-risk women... In spite of these medical interventions, our patient developed a worsening clinical picture with deteriorating renal and liver function tests which, along with severe foetal IUGR, resulting in the decision to terminate the pregnancy... As PET has been identified as a risk factor for future cardiovascular events, long-term follow-up to modify BP and cholesterol is advisable... In conclusion, this report adds further to the medical knowledge of very early PET... PET can occur before 20-week gestation and should be considered in the differential diagnosis of any pregnant woman with new-onset hypertension and proteinuria, irrespective of gestation... Kidney biopsy is safe in pregnancy and may be crucial in distinguishing PET from other glomerulopathies.

No MeSH data available.


Related in: MedlinePlus